System and method for preemptive determination of the potential for an atypical clinical event related to the administering of medication

ABSTRACT

Systems and methods provide for the preemptive determination of the potential of atypical clinical event occurrence related to administering of medications to a person. One method involves receiving a list of possible medications that may be administered to the person during a medical procedure. Subsequently, the medication list is compared to information in the person&#39;s medical record. Based on this comparison, a determination is made as to whether one or more matches exist between any of the medications included in the list and the medical record information, the match relating to the potential of an atypical clinical event occurring if the associated medication were to be administered to the person. If a match in fact exists, a response is outputted relating to each match.

RELATED TO THE ADMINISTERING OF MEDICATION

None.

CROSS-REFERENCE TO RELATED APPLICATIONS

None.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

None.

BACKGROUND OF THE INVENTION

In the health care industry, there is a desire to increase safety in theprocess of administering medications (i.e., drugs or pharmaceuticals) topatients. Recent studies have shown that adverse drug reactions (ADRs),such as drug-drug interactions and drug allergy reactions, occur at analarming rate. For instance, the Institute of Medicine reported that anestimated 106,000 deaths occurred in 1994 due to ADRs, and more than2,000,000 hospitalized patients experienced serious, if not fatal, ADRs.Lazarou J. et al., Incidence of adverse drug reactions in hospitalizedpatients: a meta-analysis of prospective studies, J. Am. Med. Assn.1998: 279: 1200-1205. While many of these reactions were attributable toprocedural errors, a significant percentage of these reactions were dueto inadequate or incomplete information regarding the likely response aparticular patient would have to the associated medication.

Sometimes the healthcare worker (e.g., nurse, anesthesiologist, etc.)administering the drug will have a patient's medical record or “chart”available for review prior to taking such action; the medical recordincludes, for example, information about drugs the patient is currentlytaking (including vitamins and other natural and synthetic remedies) orallergies to drugs that the patient is known to have. But even if thisinformation is available, the worker still must consult another set ofinformation—specifically pharmacological information regarding drug-druginteractions—to determine whether drugs the patient has already takenwould react negatively with a drug to be administered. This sort ofinformation “look-up” or “cross-checking” is subject to human error, andis time consuming, thus reducing efficiency in the delivery of healthcare services while providing only a moderate level of ADR avoidance.Moreover, such cross-checking becomes increasingly complex when multipledrugs are to be considered as candidates for administration to apatient.

BRIEF SUMMARY OF THE INVENTION

Systems and methods are implemented that facilitate preemptivedetermination of the potential for an atypical clinical event occurrencerelated to the administering of a medication to a person. In this way,incidents of ADRs and other atypical clinical events may be reduced andpatient safety improved.

In one aspect of the invention, a method in a computing system providesfor preemptive determination of the potential for atypical clinicalevent occurrence related to the administering of one or more medicationsto a person having an electronic medical record. The method includesreceiving a list of possible medications to be administered to theperson prior to or during a medical procedure. Subsequently, themedication list is compared to information in the person's medicalrecord. Based on this comparison, a determination is made as to whetherone or more matches exist between any of the medications included in thelist and the medical record information, the match relating to thepotential of an atypical clinical event occurring if the associatedmedication were to be administered to the person. If a match exists, aresponse is outputted relating to each match.

In yet another aspect, a computing system provides preemptivedetermination of the potential for atypical clinical event occurrencerelated to the administering of a medication to a person having anelectronic medical record. A receiving component of the system receivesa list of possible medications to be administered to the person prior toor during a medical procedure. This medication list is then taken by acomparing component for comparison with information in the person'smedical record. Based on this comparison, a determination is made as towhether one or more matches exists between any of the medicationsincluded in the list and the medical record information, by adetermining component. Each match relates to the potential of anatypical clinical event occurring if the associated medication were tobe administered to the person. An outputting component then outputs aresponse relating to each of the matches.

Additional advantages and novel features of the invention will be setforth in part in a description which follows, and in part will becomeapparent to those skilled in the art upon examination of the following,or may be learned by practice of the invention.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

FIG. 1 is a schematic diagram of a suitable computing system environmentfor use in implementing the present invention;

FIG. 2 is a flow diagram illustrating one method for providinginformation regarding the potential for atypical clinical eventoccurrence relating to administering a medication to a patient;

FIG. 3 illustrates a patient selection window;

FIG. 4 illustrates a medication alert window;

FIG. 5 illustrates a decision support window;

FIG. 6 illustrates a medication selection window; and

FIG. 7 is a flow diagram illustrating another method for providinginformation regarding the potential for atypical clinical eventoccurrence relating to administering medication to a patient.

DETAILED DESCRIPTION OF THE INVENTION

The present invention includes systems and methods for preemptivedetermination of the potential for atypical clinical event occurrencerelated to the administering of one or more medications to a personhaving an electronic medical record. These systems and methods functionsuch that the health care worker is made aware of risks to the patientprior to administering one or more medications. This allows forselection of alternative medications, if desired, to reduce the risk ofthe occurrence of atypical clinical events, such as ADR's.

FIG. 1 illustrates an example of a suitable medical informationcomputing system environment 20 on which the invention may beimplemented. The medical information computing system environment 20 isshown merely to facilitate understanding of the invention, and is onlyone example of a suitable computing environment. Likewise, the computingsystem environment 20 is not intended to suggest any limitation as tothe scope of use or functionality of the invention. Neither should thecomputing environment 20 be interpreted as having any dependency orrequirement relating to any one or combination of components illustratedin the exemplary environment 20.

The invention is operational with numerous other general purpose orspecial purpose computing system environments or configurations.Examples of well-known computing systems, environments, and/orconfigurations that may be suitable for use with the invention include,but are not limited to, personal computers, server computers, hand-held(e.g., PDAs) or laptop devices, multiprocessor systems,microprocessor-based systems, set top boxes, programmable consumerelectronics, network PCs, minicomputers, mainframe computers,distributed computing environments that include any of the above systemsor devices, and the like.

The invention may be described in the general context ofcomputer-executable instructions, such as program modules, beingexecuted by a computer. Generally, program modules include routines,programs, objects, components, data structures, etc. that performparticular tasks or implement particular abstract data types. Theinvention may also be practiced in distributed computing environmentswhere tasks are performed by remote processing devices that are linkedthrough a communications network. In a distributed computingenvironment, program modules may be located in both local and remotecomputer storage media, including memory storage devices.

With reference to FIG. 1, an exemplary medical information system forimplementing the invention includes a general purpose computing devicein the form of server 22. Components of server 22 may include, but arenot limited to, a processing unit, internal system memory, and asuitable system bus for coupling various system components, includingdatabase cluster 24 to the control server 22. The system bus may be anyof several types of bus structures, including a memory bus or memorycontroller, a peripheral bus, and a local bus using any of a variety ofbus architectures. By way of example, and not limitation, sucharchitectures include Industry Standard Architecture (ISA) bus, MicroChannel Architecture (MCA) bus, Enhanced ISA (EISA) bus, VideoElectronic Standards Association (VESA) local bus, and PeripheralComponent Interconnect (PCI) bus, also known as Mezzanine bus.

Server 22 typically includes therein or has access to a variety ofcomputer readable media, for instance, database cluster 24. Computerreadable media can be any available media that can be accessed by server22, and includes both volatile and nonvolatile media, removable andnonremovable media. By way of example, and not limitation, computerreadable media may comprise computer storage media and communicationmedia. Computer storage media includes both volatile and nonvolatile,removable and nonremovable media implemented in any method or technologyfor storage of information, such as computer readable instructions, datastructures, program modules or other data. Computer storage mediaincludes, but is not limited to, RAM, ROM, EEPROM, flash memory or othermemory technology, CD-ROM, digital versatile disks (DVD), or otheroptical disk storage, magnetic cassettes, magnetic tape, magnetic diskstorage, or other magnetic storage devices, or any other medium whichcan be used to store the desired information and which can be accessedby server 22. Communication media typically embodies computer readableinstructions, data structures, program modules, or other data in amodulated data signal, such as a carrier wave or other transportmechanism, and includes any information delivery media. The term“modulated data signal” means a signal that has one or more of itscharacteristics set or changed in such a manner as to encode informationin the signal. By way of example, and not limitation, communicationmedia includes wired media, such as a wired network or direct-wiredconnection, and wireless media such as acoustic, RF (e.g., Bluetooth),infrared, optical and other wireless media. Combinations of any of theabove should also be included within the scope of computer readablemedia.

The computer storage media, including database cluster 24, discussedabove and illustrated in FIG. 1, provide a storage of computer readableinstructions, data structures, program modules, and other data forserver 22. As an example, database cluster 24 may include one or moreany type of database, such as relational, hierarchical, object-oriented,and/or the like, and may be organized in any suitable manner, includingas data tables or lookup tables.

Server 22 may operate in a computer network 26 using logical connectionsto one or more remote computers 28. Remote computers 28 can be locatedat a variety of locations in a medical environment, for example, but notlimited to, hospitals, other inpatient settings, pharmacies, aclinician's office, ambulatory settings, testing labs, medical billingand financial offices, hospital administration, and a patient's homeenvironment. Clinicians include, but are not limited to, the treatingphysician, specialists such as surgeons, radiologists and cardiologists,emergency medical technicians, physician's assistants, nursepractitioners, nurses, nurse's aides, pharmacists, dieticians,microbiologists, and the like. The remote computers may also bephysically located in non-traditional medical care environments so thatthe entire health care community is capable of integration on thenetwork. Remote computers 28 may be a personal computer, hand-held(e.g., PDAs) or laptop device, cellular phone, kiosk, server, router, anetwork PC, a peer device or other common network node, and may includesome or all of the elements described above relative to server 22.Computer network 26 may be a local area network (LAN) and/or a wide areanetwork (WAN), but may also include other networks. Such networkingenvironments are commonplace in offices, enterprise-wide computernetworks, intranets and the Internet. When utilized in a WAN networkingenvironment, server 22 may include a modem or other means forestablishing communications over the WAN, such as the Internet. In anetworked environment, program modules or portions thereof may be storedin server 22, or database cluster 24, or on any of the remote computers28. For example, and not limitation, various application programs mayreside on the memory associated with any one or all of remote computers28. It will be appreciated that the network connections shown areexemplary and other means of establishing a communications link betweenthe computers may be used.

A user may enter commands and information into server 22 or convey thecommands and information to the server 22 via remote computers 28through input devices, such as keyboards, pointing devices, commonlyreferred to as a mouse, trackball, or touch pad. Other input devices mayinclude a microphone (e.g., using voice recognition techniques),satellite dish, scanner, or the like. Server 22 and/or remote computers28 may have any sort of display device, for instance, a monitor. Inaddition to a monitor, server 22 and/or computers 28 may also includeother peripheral output devices, such as speakers and printers.

Although many other internal components of server 22 and computers 28are not shown, those of ordinary skill in the art will appreciate thatsuch components and their interconnection are well known. Accordingly,additional details concerning the internal construction of server 22 andcomputer 28 need not be disclosed in connection with the presentinvention. The systems and methods of the present invention are alsodescribed as being implemented in a WINDOWS operating system operatingin conjunction with a comprehensive healthcare network or system;however, one skilled in the art would recognize that such systems andmethods can be implemented in any system supporting the receipt andprocessing of clinical agent information or genetic test results.

Operation of one embodiment of the system of the present invention forinforming a user of the potential for atypical clinical event occurrencewhen administering medication to a patient is shown in FIG. 2. The term“atypical clinical event” refers to any non-responsive or adverse eventthat may result from a patient receiving medication, examples of whichinclude drug-drug interactions (e.g., one medication or drug impedingthe chemical activity and/or the absorption of another drug), drug-foodinteractions, drug-gene interactions and drug-allergy reactions. Theterm “patient” refers to a person that is receiving medication in anylocation in a medical environment (e.g., hospitals or other inpatient oroutpatient settings, a clinician's office, ambulatory settings, testinglabs, patient's home environment, or in any other setting).

The system interacts with a pre-existing electronic medical record (EMR)of a patient, which may contain information such as the medications thepatient is currently taking (including dosage amounts and when themedications were delivered), foods the patient is consuming (and whenthey were consumed), allergies to medications that the patient is knownto have and/or genetic test results for the patient, and which may bestored on a unified healthcare network. However, the term “electronicmedical record” should not be interpreted to be limited to any type ofcomputer-readable format or record, but includes any data structurecontaining information relative to a specific patient and from whichinformation may be extracted by the system of the present invention. Themethod of use of the system may also include steps requiringauthorization of the user to access particular patient information andsimilar security measures known by those of skill in the art.

The system embodiment shown in FIG. 2 is also configured to interactwith one or more pre-built medication-procedure tables, which maintain astandard list or set of medications—optionally, with a recommendeddosage amount for each—that may be administered during a specific typeof medical procedure or treatment. For example, one type of medicalprocedure may include a grouping of many individual procedures (e.g.,any procedure where anesthesia is used), or may include a specific kindof surgical procedure (e.g., appendectomy); however, it should beappreciated that a medical procedure may also be any other type ofprocedure (a radiologic or oncologic medical procedure, as otherexamples). Additionally, the medication-procedure tables may include auniversal set of medications that may be administered regardless of thetype of medical procedure or treatment, such that the universal set iseffectively associated with all procedures (e.g., a set of medicationsdetermined to be of a particularly dangerous nature when administered inany type of medical procedure). Each medication may also carry a type orcategory designation (e.g., antibiotic, antidrhythmic, etc.) within themedication-procedure tables. Preferably, the medication-procedure tablesare stored in the memory of the system such as in the database cluster24.

Thus, clinicians can use the medication-procedure tables as a templatefor the medications that are oftentimes administered to a patient in agiven medical procedure (or medications that may be administeredregardless of the type of procedure). Additionally, themedication-procedure tables may be edited or updated at any time asstandard protocol is changed for what specific medications are optionalfor administering to a patient during a given type of medical procedure.

In a first step, the system requests the selection of the particularpatient for which the pre-built set of possible medications to beadministered is to be checked in step 100. By way of example, as seen inFIG. 3, an exemplary user interface window 30 of the conventional kindis shown for requesting patient selection. Preferably, displaying ofwindow 30 and patient selection is conducted at one of the remotecomputers 28 and transmitted to the control server 22 via the network26. Any of a number of input devices, displays, and techniques may alsobe utilized at this step of the method and in each of the subsequentsteps wherein user input is received and/or information displayed.

The patient may be selected from a list of patients extracted from;patient-procedure entries stored in the unified healthcare network. Eachpatient-procedure entry includes information about a patient and acorresponding medical procedure the patient is scheduled to undergo, forexample, the patient's name, social security number, type of procedureto undergo, location where the procedure is to take place, or any otherrelated information. Information contained in the patient-procedureentries is typically gathered at events such as during a pre-operativemeeting, but maybe gathered at any other time prior to system step 100.

The patient list may be displayed on the user interface window 30 in avariety of ways. For instance, the clinician operating the system mayview a scrollable table 32 of the patient-procedure entries—in thiscase, each relating to a surgical procedure—and select the desired entryfrom the list with an input device (e.g., a mouse), or may select apatient by inputting information in one of the associated text boxes 34of window 30 and searching for the patient by information such as anassigned case number, the anesthesiologist treating the patient duringthe procedure, etc.

Upon selection of the patient, a procedure-specific patient record isbuilt by the system of the present invention at step 102, which may bestored in the memory of the system such as in the database cluster 24.The procedure-specific patient record incorporates the information fromthe selected patient-procedure entry.

Now having the particular patient identified by the system, thepatient's existing electronic medical record (EMR) is retrieved from theunified healthcare network by the system at step 104. Information isthen extracted from the electronic medical record and from the pre-builtmedication-procedure table for the particular medical procedure chosen,at step 106. Preferably, the information from the patient's electronicmedical record includes medications the patient is taking or hasrecently taken (including pharmaceuticals, vitamins, natural andsynthetic remedies and the like), foods that have beeningested/consumed, medication allergies and/or genetic test results, andinformation from the table includes the set of medications associatedwith the particular procedure. This extracted information is preferablyincorporated into the procedure-specific patient record such that thisrecord displays for the clinician desired information about the patientand the scheduled medical procedure. Additionally, the extractedinformation may also include patient information such as their age orweight, which may be relevant to the dosage of the medications in themedication-procedure tables in terms of the likelihood of atypicalclinical event occurrence. Alternatively, the clinician may themselvesenter onto the system the patient-specific characteristics includingpatient age and/or weight instead of such information being extractedfrom the associated patient medical record.

One optional step of the system, step 108, includes displaying of theset of medications for the particular medical procedure chosen. Thisallows the clinician to edit the set (e.g., add or remove medications)as they desire and incorporate the edited medication set into theprocedure-specific patient record.

At step 110, the system takes the extracted information from step 106(and optionally step 108), and accesses a drug-drug, drug-foodassociation table to make a comparison regarding the potential foratypical clinical event occurrence if one or more of the medications areadministered to the patient. The association table may be maintained inthe memory of the system such as in database cluster 24, or elsewherewithin the system or within the comprehensive healthcare network. Forexample, the association table may be accessed via a global computernetwork such as the Internet rather than being stored in databasecluster 24 as described above with reference to one preferredembodiment. One example of a suitable association table is the drug-drugand/or drug-food association table maintained by Cerner Multum. Thetable includes information regarding adverse affects caused by two ormore specific medications interacting with one another within a person,or by a medication and a food interacting within a person. For instance,one of the aforementioned interactions may include the magnification ofthe effects of the administered medication beyond what is desired, orone medication impeding the chemical activity and absorption of anothermedication, purely as examples. The table may further containinformation on the severity of the adverse effects relative to thedosage of the administered medication and the age or weight of theperson receiving the medication. As appreciated by those of skill in theart, a particular medication may interact with more than one othermedication, or with more than one type of food. Additionally, as moreinformation about drug-drug and drug-food interactions is learned, thisinformation may be added to the particular drug-drug and/or drug-foodassociation table used in conjunction with the present invention.

At step 112, a determination is made as to whether one or more matchesexists between the medication information in the medication-proceduretable and the patient medical record information. This determinationinvolves both (a) drug-allergy reactions matched by direct comparisonbetween the medication-procedure table and the patient's medical recordinformation, (b) drug-drug and drug-food interactions matched bycomparison between the medication-procedure table and the patient'smedical record information through the drug-drug and/or drug-foodassociation table. As one example, if the patient is undergoing amedical procedure where the medication Ampicillin is one choice ofantibiotic that may be administered, step 116 determines both if thespecific patient is known to be allergic to Ampicillin and, throughconsulting the association table, whether Ampicillin will cause anadverse outcome through a drug-drug or drug-food interaction with amedication or food the patient has consumed or taken. The matchesrelating to drug-drug and drug-food interactions may also depend on thedosage of the medication to be administered, such that the severity ofthe adverse outcome may be gauged.

If one or more matches are found, then at step 114, the system outputs aresponse notifying the clinician of each match. FIG. 4 shows oneexemplary response relating to a drug-drug interaction match between theantibiotics Gentamicin and Ampicillin. The response is in the form of amedication alert window 36 provided on a display of the system. Thewindow 36 presents a number of alert boxes 38, preferably one for eachmatch found by the system. In this representative example, only onematch was found, therefore only one alert box is generated by thesystem. Each alert box 38 may include, for example, the specificmedication that may be administered involved in the particular match,the category of the medication(s) involved in the match (in thisrepresentative example, antibiotics), the type of match (which may bedenoted by the initials “D” for drug-drug, “A” for drug-allergy, “F” fordrug-food, and “G” for drug-gene), and the predicted severity of theassociated atypical clinical event (e.g., mild, moderate or severeindicated by arrows or other graphical symbols or audible alerts). Thealert box 38 may further include, in addition to the medication that mayoptionally be administered, the medication or food the patient hasingested/taken, and may also include an indication whether the dose ofmedication is excessive and could result in an overdosing of the patient(e.g., if the patient is a pediatric patient—as determined from thepatient information gathered—and the medication dosage is an adultdosage—based on strength and concentration—as determined from themedication-procedure tables). Additionally, patient information 35associated with the procedure-specific patient record may be displayedon window 30 or on any other window of the system. This information 35may include, for example, the patient's name, date of birth, and otherpersonal information, as well as the medical procedure to be performedon the patient and allergies the patient has, and other relatedinformation.

Each alert box 38 may be selected by the clinician to view more detailedinformation about the type of match, at step 116. FIG. 5 shows anexemplary decision support window 40 displayed once an alert box 38 hasbeen selected. In this particular case, the representative alert box(not shown) included Ampicillin as the medication that may beadministered, and returned drug-drug, drug-food and drug-allergy matchesfor the patient. A table 42 lists each match for Ampicillin and displaysthe type of match (denoted by the initial representative of the match),the severity of the atypical clinical event, and what the medicationinteracts with (i.e., medication or food the patient hasconsumed/taken). The clinician may scroll through the table 42 to selecta particular match entry, for example, the drug-drug interaction betweenAmpicillin and Gentamicin, and sub windows 44, 46 display medical,pharmacological or other evidence-based information relating to thematch and to the medication that may be administered. Subsequently, theclinician may close the decision support window 40 and select anotheralert box 38 to view information about other matches.

Once the clinician is satisfied that sufficient information about thematches and associated atypical clinical events has been considered, themedication alert window 36 may be closed and the system displays anexemplary select medication window 48 at step 118, and as shown in FIG.6. Additionally, if no matches were found in step 112, the system movesdirectly to step 118.

At step 118 the select medication window 48 provides the medicationsthat may be administered (from the medication-procedure table) inmedication boxes 50, and is preferably segmented into medicationcategories (e.g., antibiotics, antidrhythmics, etc.) so that theclinician may select the appropriate medication(s) for administration.Each of the medication categories may be indexed on a tab 52 such thatthe clinician can move easily between categories to see the medicationoptions. Each medication box 50 lists the medication name, and may alsoprovide the medication trade name, the recommended dosage for thepatient (if patient-specific characteristics are known), and the type ofmatch, if any, that was discovered, as well as the predicted severity ofthe associated atypical clinical event (not shown). In this particularexample, medication boxes for the medication Garamycin are shown andinclude a “D” to indicate a drug-drug interaction as an atypicalclinical event if this medication is administered to the patient. Thewindow 48 also provides selection boxes 54 that control the function ofuser selections made to the medication boxes 50. In other words, theselection boxes 54 modify the function of “clicking” on or otherwiseselecting a selected box 50. For instance, the clinician may add orremove a medication to or from the procedure-specific patient record foradministration to the patient in association with the selected medicalprocedure, modify the medication dosage suggested, or remove a specificmedication box 50, thereby removing the associated medication from themedication-procedure table such that the medication will not bepresented in the future as an option when the associated medicalprocedure is selected.

At step 120, the clinician, in the select medication window 48, makesthe desired medication selections in each medication category tocomplete the list of medications to be added to the procedure-specificpatient record and administered to the particular patient. Thus, theclinician is properly informed of the risks of the occurrence of adversedrug events in the patient and may tailor their medication selection toavoid such risks.

As discussed above, the system embodiment of FIG. 2 may also beapplicable to drug-gene interactions. This is useful because of theindividual variability in the response to drugs due to the differencesin genetic makeup between any two given persons. In one example ofoperation of the system embodiment of FIG. 2, the medications list for agiven medical procedure may be compared with a table of gene variationsand associated polymorphisms accessed at system operation step 110.Information from the patient's medical record or other record regardinggenetic testing information is also extracted at system operation step106. Then, at step 112, a determination may also be made as to whetherone or more matches exists between the medication information in themedication-procedure table and patient's genetic testing informationthat would result in an adverse or atypical outcome. Each alert box mayinclude the specific medication that may be administered involved in theparticular match, the category of the medication(s) involved in thematch (in this representative example, antibiotics), the type of match(such as a “G” for drug-gene), and the predicted severity of theassociated atypical clinical event (e.g., mild, moderate or severeindicated by arrows or other graphical symbols or audible alerts). Oneexample of an atypical outcome would be that a given medication may benon-responsive and not provide the patient with the intended benefit. Ifone or more matches exist, associated responses are outputted in step114 (e.g., displayed on alert box 38, FIG. 4) along with informationrelated to matches, such as phenotypes, risks, etc.

FIG. 7 shows the operation of another embodiment of the system of thepresent invention for informing a user of the potential for atypicalclinical event occurrence when administering medication to a patient.The system embodiment of FIG. 7 shares some similarities to theembodiment of the system of FIG. 2, but medications that may beadministered are gathered relative to a particular patient, not justwith respect to a particular medical procedure alone. Also, terms usedabove to describe the system embodiment of FIG. 2 should be interpretedconsistently with respect to the system embodiment shown in FIG. 7.

The operation of the system of FIG. 7 begins with the clinician or otherindividual inputting into the system medications that may beadministered specific to a particular patient undergoing a certainmedical procedure or treatment, at step 200, such that a list ofmedications is generated. Accordingly, patient and procedure identifyinginformation relating to the list is also inputted in this step, someexamples of which include the patient's name, social security number,location whether the procedure is to take place, patient-specificcharacteristics, or any other related information. Still further, otherinformation associated with each medication may also be inputted, suchas a dosage amount for the respective medication based on the specificmedical procedure to be conducted and/or other factors, and a type orclassification designation for the medication.

The gathering of patient/procedure and medication information in step200 may occur at any time once it is determined that the patient isscheduled to undergo a specific medical procedure (e.g., at apre-operative meeting). Likewise, this information may be stored as anytype of data structure, for example, compiled into a medication-patienttable, in the memory of the system (e.g., in database cluster 24), andis preferably inputted into the system at one of the remote computers 28and transmitted to the control server 22 via the network 26. Any of anumber of input devices, displays, and techniques may be utilized atthis step of the method and in each of the subsequent steps wherein userinput is received and/or information displayed. As with the system ofFIG. 2, the term “medical procedure” signifies any type of procedure ortreatment; purely as an example, one type of medical procedure would beany procedure where anesthesia is used.

Subsequently, at step 202, when the clinician is ready to determine thepotential for atypical clinical event occurrence upon administeringdrugs to a patient for a given medical procedure, the system requeststhe selection of the particular patient for which the list of possiblemedications to be administered is to be checked (e.g., from a list ofpatients extracted from patient-procedure entries stored in the unifiedhealthcare network). This step is similar to step 104 of the systemembodiment of FIG. 2, and patient information may be requested throughthe exemplary user interface window 30 of FIG. 3 and by use of thescrollable table 32 or text boxes 34 of the window 30 to select aparticular patient entry.

Upon selection of the patient, at step 204 the system builds aprocedure-specific patient record, which may be stored in the memory ofthe system such as in the database cluster 24. The procedure-specificpatient record incorporates the information from the selected patiententry. Then, at step 206 and having the particular patient identified bythe system, the patient's electronic medical record is retrieved fromthe comprehensive healthcare network by the system. Information is thenextracted from the medical record and from the medication-patient tablegathered in step 200, at step 208. Preferably, the information from thepatient's medical record includes medications the patient is taking orhas recently taken, foods that have been ingested/consumed andmedication allergies, and information from the table includes a listingof the medications associated with the particular procedure. Thisextracted information is preferably incorporated into theprocedure-specific patient record such that this record displays for theclinician desired information about the patient and the scheduledmedical procedure. Also, in the same fashion as the operation of thesystem embodiment of FIG. 2 in step 106, the extracted information mayalso include patient information such as their age or weight, which maybe relevant to the dosage of the medications in the medication-proceduretables in terms of the likelihood of atypical clinical event occurrence.Alternatively, in step 210, the clinician may themselves enter onto thesystem the patient-specific characteristics instead of such informationbeing extracted from the associated patient medical record, so that theproper dosage amount may be determined.

Steps 212-222 of the system embodiment of FIG. 7 are essentiallyidentical to steps 110-120 of the system embodiment of FIG. 2, and willmerely be briefly summarized herein.

At step 212, the system takes the extracted information from step 208(and optionally step 210), and accesses a drug-drug and/or drug-foodassociation table to make a comparison regarding the potential ofatypical clinical event occurrence if one or more of the medications areadministered to the patient, including the severity of any adverseeffects. Then, at step 214, a determination is made as to whether one ormore matches exists between the medication information in themedication-procedure table and the patient medical record information,which involves both (a) drug-allergy reactions matched by directcomparison between the medication-procedure table and the patient'smedical record information, and (b) drug-drug and drug-food interactionsmatched by comparison between the medication-procedure table and thepatient's medical record information through the drug-drug and/ordrug-food association table. The matches relating to drug-drug anddrug-food interactions may also depend on the dosage of the medicationto be administered, such that the severity of the atypical clinicalevent may be gauged.

If one or more matches are found, the system outputs a responsenotifying the clinician of each match, at step 216, and as shown in FIG.4. The medication alert 36 presents the exemplary alert box 38 notifyingof the drug-drug interaction match between the antibiotics Gentamicinand Ampicillin. The alert box 38 may include the medication name(s), thecategory of the medication(s) involved in the match, the type of match,the predicted severity of the associated atypical clinical event, amongother information. Patient information 35 associated with theprocedure-specific patient record may be displayed on window 30.Additionally, at step 218, selection of the alert box 38 will take theclinician to the exemplary Decision Support window 40 shown in FIG. 5.The table 42 lists each match for Ampicillin (in this particularexample) and displays the type of match, the severity of the atypicalclinical event, and with what the medication will interact. If theexemplary drug-drug interaction shown, between Ampicillin andGentamicin, is selected the sub windows 44, 46 display medical orpharmacological information relating to the match and to the medicationthat may be administered.

Once the clinician is satisfied that they have been presented withsufficient information about the matches and associated atypicalclinical events, the medication alert window 36 may be closed and thesystem displays the exemplary Select Medication window 48 at step 220,and as shown in FIG. 6. Additionally, if no matches were found in step214, the system moves directly to step 220.

At step 220, the select medication window 48 provides the medicationsthat may be administered (from the medication-patient table) inmedication boxes 50, and preferably broken down into medicationcategories so that the clinician may select the appropriatemedication(s) for administration. Each of the medication categories maybe indexed on a tab 52 such that the clinician can move easily betweencategories to see the medication options. Selection boxes 54 may also beprovided by the window 48 for controlling the function of userselections made to the medication boxes 50. Then, at step 222, theclinician can make the desired medication selections in each medicationcategory (through window 48) to complete the list of medications to beadded to the procedure-specific patient record and administered to theparticular patient.

Similar to the system embodiment of FIG. 2, the system embodiment ofFIG. 7 may, as well, be applicable to drug-gene interactions within aperson. One exemplary operation for the system embodiment would includethe comparison of the medication list for a given patient undergoing amedical procedure with a table of gene variations and associatedpolymorphisms accessed at system operation step 212. Additionally,information from the patient's medical record or other record regardinggenetic testing information is also extracted at system operation step208. A determination may then be made, at step 214, as to whether one ormore matches exist between the medication information in the medicationlist and patient's genetic testing information that would result in anatypical clinical event. In other words, the system determines if theproducts of the genes are likely to interact with the medications on thelist to result in an atypical clinical event. If one or more matchesexist, associated responses are outputted in step 216 along withinformation related to matches (phenotypes, risks, etc).

EXAMPLE

One example of a particular usage of the system embodiments of FIGS. 2and 7 is with gauging the potential of atypical clinical eventoccurrence when considering medication options for a surgical procedurewhere anesthesia is used. As seen in FIG. 3—whether a list of potentialmedications that may be administered is created for a type of proceduregenerally (as in the system of FIG. 2) or with respect to a specificpatient and procedure (as in the system of FIG. 7)—the patient issearched for in user interface window 30 by the associated operatingroom, anesthesiologist, starting dates and time for the scheduledmedical procedure, or by other identifying information. In thisparticular case, the anesthesia medication list includes those that arechoices for administering to the patient by a clinician, includingmedications in the categories of antibiotics, antidrhythmics, intubationmedications, pre-operative medications, anticholinergics, and reversalagents, among others. Based on the anesthesia medication list, thesystem returns a match for the drug-drug interaction between garamycinand ampicillin in the alert box 38 of FIG. 4. Selecting the box displaysthe decision support window 40, which provides information about theassociated drug-drug interaction, as well as pharmacology, and warninginformation related to the selected drug, in this case, ampicillin. Theclinician then selects, in the select medication window 48 of FIG. 6,the tab 52 relating to each category of medication that may beadministered until all of the proper medication necessary for thesurgical procedure are chosen. Here, the clinician is reviewing themedication options for the antibiotics that may be administered, notingthat the medication boxes 50 show that Garamycin, in the listed dosageoptions, may cause a drug-drug interaction with medication thisparticular patient has taken. Therefore, the clinician should choose oneof the other medication boxes 50 to administer a different antibioticfor the patient before or during the medical procedure.

As can be seen, the present systems and methods provide a robustsolution for reducing the occurrence of ADR's and other similar atypicalclinical events when a patient is to receive certain medications inconjunction with undergoing a medical procedure, such as a surgery. Thefeatures of the present invention provide for the customization of alist of medication options that may be chosen from when needed for aspecific medical procedure. By checking a meaningful list of medicationssimultaneous for atypical clinical events, instead of having the usercheck medications individually, substantial time savings are realized,and the burden on the clinician is reduced, making it more likely thathe or she will check all of the medication choices for possible ADR's.At the same time, it should be understood that a clinician may desire toonly check certain medications of a group that may be administered to apatient, or a certain family of medications (e.g., antibiotics), withthe systems of the present invention, if the clinician is aware thatother medications that may be administered will not cause an atypicalclinical event to occur.

The systems and methods of the present invention also provide value inclinical situations where medications are not ordered prior to aprocedure taking place, but are administered immediately after aclinician deems them necessary (e.g., antibiotics for a trauma patientin an emergency room). In this way, the clinician may check a medicationlist, and if the system determines that there is no significant risk ofan atypical clinical event occurring, the clinician can promptlyadminister the medication.

Furthermore, since certain changes may be made in the above systems andmethods without departing from the scope hereof, it is intended that allmatter contained in the above description or shown in the accompanyingdrawing be interpreted as illustrative and not in a limiting sense. Itis also to be understood that the following claims are to cover certaingeneric and specific features described herein.

1. A method in a computing system for preemptive determination of thepotential for atypical clinical event occurrence related to theadministering of at least one medication to a person having anelectronic medical record, comprising the steps of: accessing a list ofpossible medications that may be administered prior to or during amedical procedure; comparing the medication list to information in aperson's medical record; and determining whether at least one matchexists between any of the medications included in the list and therecord information, the match relating to the potential of an atypicalclinical event occurring if the associated medication were to beadministered to the person, and if there is a match, outputting aresponse relating to each match.
 2. The method of claim 1, wherein thestep of accessing a list of possible medications comprises accessing alist of possible medications that may be administered to a specificperson scheduled to undergo a specific type of medical procedure, andwherein the step of comparing the medication list comprises comparingthe medication list to information in the specific person's medicalrecord.
 3. The method of claim 1, wherein accessing a list of possiblemedications comprises accessing a list of possible medications that maybe administered to any person scheduled to undergo a specific type ofmedical procedure, and further comprising the steps of selecting aperson to undergo the medical procedure and receiving at least one ofthe medications from the list of medications.
 4. The method of claim 1,wherein the atypical clinical event is one selected from the groupconsisting of a drug-drug interaction, drug-food interaction, adrug-allergy interaction, and a drug-gene interaction.
 5. The method ofclaim 1, wherein the medical procedure includes any medical procedurerequiring the use of anesthesia.
 6. The method of claim 1, wherein thelist of possible medications includes medications used in a medicalprocedure involving anesthesia.
 7. The method of claim 1, wherein thelist of possible medications includes medications used in a radiologicmedical procedure.
 8. The method of claim 1, wherein the list ofpossible medications includes medications used in an oncologic medicalprocedure.
 9. The method of claim 1, wherein the information in theperson's medical record includes a list selected from one of the groupsconsisting of medications the person is currently taking or has recentlytaken, foods the person has consumed, the person's allergies tomedications and genetic test information for the person.
 10. The methodof claim 1, wherein the response includes a listing of the match and theassociated atypical clinical event, and wherein the atypical clinicalevent is one selected from the group consisting of a drug-druginteraction, drug-food interaction, drug-allergy interaction and adrug-gene interaction.
 11. The method of claim 10, wherein the list ofpossible medications includes a dosage amount for each medication in thelist, and wherein the response further includes an indication of thepredicted severity of the atypical clinical event.
 12. The method ofclaim 10, further comprising displaying information about at least onemedication of the list of possible medications that is involved in thematch upon selection of the medication at the response.
 13. The methodof claim 1, wherein the list of possible medications is received over acommunication network from a remote computing device.
 14. The method ofclaim 1, further comprising: selecting the person from a list ofperson's scheduled for a medical procedure; and accessing the person'smedical record prior to comparing the medication list to information inthe person's medical record.
 15. The method of claim 1, wherein the stepof determining whether at least one match exists includes querying adata structure containing information selected from one of the groupsconsisting of drug-drug interactions and drug-food interactions, anddetermining if each at least one match correlates with one of thedrug-drug interactions and drug-food interactions.
 16. The method ofclaim 1, further comprising retrieving a specific person's medicalrecord prior to comparing the medication list to information in theperson's medical record.
 17. A method in a computing system forpreemptive determination of the potential for atypical clinical eventoccurrence related to the administering of at least one medication to aperson having an electronic medical record, comprising the steps of:accessing a pre-defined list of possible medications that may beadministered prior to or during a medical procedure; comparing themedication list to information in a person's medical record; anddetermining whether at least one match exists between any of themedications included in the list and the record information, the matchrelating to the potential of an atypical clinical event occurring if theassociated medication were to be administered to the person, and ifthere is a match, outputting a response relating to each match.
 18. Themethod of claim 17, wherein the atypical clinical event is one selectedfrom the group consisting of a drug-drug interaction, drug-foodinteraction, a drug-allergy interaction, and a drug-gene interaction.19. The method of claim 17, wherein the medical procedure includes anymedical procedure requiring the use of anesthesia.
 20. The method ofclaim 17, wherein the list of possible medications includes medicationsused in a medical procedure involving anesthesia.
 21. The method ofclaim 17, wherein the information in the person's medical recordincludes a list selected from one of the groups consisting ofmedications the person is currently taking or has recently taken, foodsthe person has consumed, the person's allergies to medications andgenetic test information for the person.
 22. The method of claim 17,wherein the response includes a listing of the match and the associatedatypical clinical event, and wherein the atypical clinical event is oneselected from the group consisting of a drug-drug interaction, drug-foodinteraction, drug-allergy interaction and a drug-gene interaction. 23.The method of claim 22, wherein the list of possible medicationsincludes a dosage amount for each medication in the list, and whereinthe response further includes an indication of the predicted severity ofthe atypical clinical event.
 24. The method of claim 22, furthercomprising displaying information about at least one medication of thelist of possible medications that is involved in the match uponselection of the medication at the response.
 25. The method of claim 17,further comprising: selecting the person from a list of person'sscheduled for a medical procedure; and accessing the person's medicalrecord prior to comparing the medication list to information in theperson's medical record.
 26. The method of claim 17, wherein the step ofdetermining whether at least one match exists includes querying a datastructure containing information selected from one of the groupsconsisting of drug-drug interactions and drug-food interactions, anddetermining if each at least one match correlates with one of thedrug-drug interactions and drug-food interactions.
 27. The method ofclaim 17, further comprising retrieving a specific person's medicalrecord prior to comparing the medication list to information in theperson's medical record.
 28. The method of claim 17, further comprisingmodifying the medication list by adding or deleting medications from thelist prior to comparing the medication list to information in theperson's medical record.
 29. A method in a computing system forpreemptive determination of the potential for atypical clinical eventoccurrence related to the administering of at least one medication to aperson having an electronic medical record, comprising the steps of:accessing a pre-defined list of possible medications that may beadministered; comparing the medication list to information in a person'smedical record; and determining whether at least one match existsbetween any of the medications included in the list and the recordinformation, the match relating to the potential of an atypical:clinical event occurring if the associated medication were to beadministered to the person, and if there is a match, outputting aresponse relating to each match.
 30. The method of claim 29, wherein theat least one medication is to be administered to the person prior to orduring a medical procedure, and wherein the medication list includes auniversal set of medications that may be administered regardless of thetype of medical procedure.
 31. The method of claim 29, wherein theatypical clinical event is one selected from the group consisting of adrug-drug interaction, drug-food interaction, a drug-allergyinteraction, and a drug-gene interaction.
 32. The method of claim 29,wherein the at least one medication is to be administered to the personprior to or during a medical procedure, and wherein the medicalprocedure includes any medical procedure requiring the use ofanesthesia.
 33. The method of claim 29, wherein the information in theperson's medical record includes a list selected from one of the groupsconsisting of medications the person is currently taking or has recentlytaken, foods the person has consumed, the person's allergies tomedications and genetic test information for the person.
 34. The methodof claim 29, wherein the response includes a listing of the match andthe associated atypical clinical event, and wherein the atypicalclinical event is one selected from the group consisting of a drug-druginteraction, drug-food interaction, drug-allergy interaction and adrug-gene interaction.
 35. A computing system for preemptivelydetermining the potential for atypical clinical event occurrence relatedto the administering of a medication to a person having an electronicmedical record, comprising: a receiving component that receives a listof possible medications that may be administered prior to or during amedical procedure; a comparing component for comparing the medicationlist to information in a person's medical record; a determiningcomponent that determines whether a match exists between any of themedications included in the list and the medical record information, thematch relating to the potential of an atypical clinical event occurringif the associated medication were to be administered to the person; andan outputting component that outputs a response relating to each match.36. The system of claim 35, wherein the receiving component receives alist of possible medications that may be administered to a specificperson scheduled to undergo a specific type of medical procedure, andwherein the comparing component compares the medication list toinformation in the specific person's medical record.
 37. The system ofclaim 35, wherein the receiving component receives a list of possiblemedications that may be administered to any person scheduled to undergoa specific type of medical procedure, and further comprising a selectingcomponent for selecting a person to undergo the medical procedure andreceive at least one of the medications from the list of medications.38. The computing system of claim 35, wherein the atypical clinicalevent is one selected from the group consisting of a drug-druginteraction, drug-food interaction, drug-allergy interaction and adrug-gene interaction.
 39. The computing system of claim 35, wherein thelist of possible medications received includes medications used in amedical procedure involving anesthesia.
 40. The computing system ofclaim 35, wherein the list of possible medications received includesmedications used in a radiologic medical procedure.
 41. The computingsystem of claim 35, wherein the list of possible medications receivedincludes medications used in a oncologic medical procedure.
 42. Thecomputing system of claim 35, further comprising a retrieving componentthat retrieves a specific person's medical record from a unifiedhealthcare system, and wherein information in the medical recordincludes a list selected from one of the groups consisting ofmedications the person is currently taking or has recently taken, foodsthe person has consumed the person's allergies to medications andgenetic test information for the person.
 43. The computing system ofclaim 35, wherein the outputting component includes a display componentthat displays the outputted response as a listing of at least one of thematches and the associated atypical clinical event, and wherein theatypical clinical event is one selected from the group consisting of adrug-drug interaction, drug-food interaction, drug-allergy interactionand a drug-gene interaction.
 44. The computing system of claim 44,wherein the list of possible medications received includes a dosageamount for each medication in the list, and wherein the outputtedresponse further includes an indication of the predicted severity of theatypical clinical event.
 45. The computing system of claim 44, furthercomprising a selecting component for selecting a medication of the listof possible medications that is involved in the match, and wherein thedisplay component displays information about the selected medication.46. The computing system of claim 35, wherein the receiving componentreceives the list of possible medications to be administered over acommunication network from a remote computing device.
 47. The computingsystem of claim 35, wherein the determining component includes aquerying component that queries a data structure containing informationselected from one of the groups consisting of drug-drug interactions anddrug-food interactions, and wherein the determining component determinesif each at least one match correlates with one of the drug-druginteractions and drug-food interactions.
 48. A computing system forpreemptively determining the potential for atypical clinical eventoccurrence related to the administering of a medication to a personhaving an electronic medical record, comprising: an accessing componentthat accesses a pre-defined list of possible medications that may beadministered prior to or during a medical procedure; a comparingcomponent for comparing the medication list to information in a person'smedical record; a determining component that determines whether a matchexists between any of the medications included in the list and themedical record information, the match relating to the potential of anatypical clinical event occurring if the associated medication were tobe administered to the person; and an outputting component that outputsa response relating to each match.
 49. The computing system of claim 48,wherein the atypical clinical event is one selected from the groupconsisting of a drug-drug interaction, drug-food interaction,drug-allergy interaction and a drug-gene interaction.
 50. The computingsystem of claim 48, wherein the list of possible medications receivedincludes medications used in a medical procedure involving anesthesia.51. The computing system of claim 48, further comprising a retrievingcomponent that retrieves a specific person's medical record from aunified healthcare system, and wherein information in the medical recordincludes a list selected from one of the groups consisting ofmedications the person is currently taking or has recently taken, foodsthe person has consumed the person's allergies to medications andgenetic test information for the person.
 52. The computing system ofclaim 48, wherein the outputting component includes a display componentthat displays the outputted response as a listing of at least one of thematches and the associated atypical clinical event, and wherein theatypical clinical event is one selected from the group consisting of adrug-drug interaction, drug-food interaction, drug-allergy interactionand a drug-gene interaction.
 53. The computing system of claim 52,wherein the list of possible medications received includes a dosageamount for each medication in the list, and wherein the outputtedresponse further includes an indication of the predicted severity of theatypical clinical event.
 54. The computing system of claim 52, furthercomprising a selecting component for selecting a medication of the listof possible medications that is involved in the match, and wherein thedisplay component displays information about the selected medication.55. The computing system of claim 48, wherein the receiving componentreceives the list of possible medications to be administered over acommunication network from a remote computing device.
 56. The computingsystem of claim 48, wherein the determining component includes aquerying component that queries a data structure containing informationselected from one of the groups consisting of drug-drug interactions anddrug-food interactions, and wherein the determining component determinesif each at least one match correlates with one of the drug-druginteractions and drug-food interactions.
 57. A computer-readable mediumcontaining instructions for controlling a computing system forpreemptive determination of the potential for atypical clinical eventoccurrence related to the administering of at least one medication to aperson having an electronic medical record, comprising the steps of:receiving a list of possible medications that may be administered priorto or during a medical procedure; comparing the medication list toinformation in a person's medical record; and determining whether atleast one match exists between any of the medications included in thelist and the record information, the match relating to the potential ofan atypical clinical event occurring if the associated medication wereto be administered to the person, and if there is a match, outputting aresponse relating to each match.
 58. The computer-readable medium ofclaim 57, wherein receiving a list of possible medications comprisesreceiving a list of possible medications that may be administered to aspecific person scheduled to undergo a specific type of medicalprocedure, and wherein comparing the medication list comprises comparingthe medication list to information in the specific person's medicalrecord.
 59. The computer-readable medium of claim 57, wherein receivinga list of possible medications comprises receiving a list of possiblemedications that may be administered to any person scheduled to undergoa specific type of medical procedure, and further comprising selecting aperson to undergo the medical procedure and receive at least one of themedications from the list of medications.
 60. The computer-readablemedium of claim 57, wherein the atypical clinical event is one selectedfrom the group consisting of a drug-drug interaction, drug-foodinteraction, a drug-allergy interaction, and a drug-gene interaction.61. The computer-readable medium of claim 57, wherein the medicalprocedure includes any medical procedure requiring the use ofanesthesia.
 62. The computer-readable medium of claim 57, wherein thelist of possible medications includes medications used in a medicalprocedure involving anesthesia.
 63. The computer-readable medium ofclaim 57, wherein the list of possible medications includes medicationsused in a radiologic medical procedure.
 64. The computer-readable mediumof claim 57, wherein the list of possible medications includesmedications used in a oncologic medical procedure.
 65. Thecomputer-readable medium of claim 57, wherein the information in theperson's medical record includes a list selected from one of the groupsconsisting of medications the person is currently taking or has recentlytaken, foods the person has consumed, the person's allergies tomedications and genetic test information for the person.
 66. Thecomputer-readable medium of claim 57, wherein the response includes alisting of the match and the associated atypical clinical event, andwherein the atypical clinical event is one selected from the groupconsisting of a drug-drug interaction, drug-food interaction,drug-allergy interaction and drug-gene interaction.
 67. Thecomputer-readable medium of claim 66, wherein the list of possiblemedications includes a dosage amount for each medication in the list,and wherein the response further includes an indication of the predictedseverity of the atypical clinical event.
 68. The computer-readablemedium of claim 66, further comprising displaying information about atleast one medication of the list of possible medications that isinvolved in the match upon selection of the medication at the response.69. The computer-readable medium of claim 57, wherein the list ofpossible medications is received over a communication network from aremote computing device.
 70. The computer-readable medium of claim 57,further comprising: selecting the person from a list of person'sscheduled for a medical procedure; and retrieving the person's medicalrecord prior to comparing the medication list to information in theperson's medical record.
 71. The computer-readable medium of claim 57,wherein the step of determining whether at least one match existsincludes querying a data structure containing information selected fromone of the groups consisting of drug-drug interactions and drug-foodinteractions, and determining if each at least one match correlates withone of the drug-drug interactions and drug-food interactions.
 72. Thecomputer-readable medium of claim 57, further comprising retrieving aspecific person's medical record prior to comparing the medication listto information in the person's medical record.
 73. A computer-readablemedium containing instructions for controlling a computing system forpreemptive determination of the potential for atypical clinical eventoccurrence related to the administering of at least one medication to aperson having an electronic medical record, comprising the steps of:accessing a pre-defined list of possible medications that may beadministered prior to or during a medical procedure; comparing themedication list to information in a person's medical record; anddetermining whether at least one match exists between any of themedications included in the list and the record information, the matchrelating to the potential of an atypical clinical event occurring if theassociated medication were to be administered to the person, and ifthere is a match, outputting a response relating to each match.